Are American Women Out of Touch with the Reality of Childbirth Facilities?

In the one week following the premier of One Born Every Minute, I heard a lot of criticism of the couple who made the decision to have a natural childbirth in a hospital setting. Most comments I came across called them rude, and out of touch with reality… even as far as accusing them of purposely trying to harm their baby by not listening to their nurse.

But what bothered me most was the comment that this couple was that so many people felt they had no business in the hospital, throwing around statements like, “They should have had a home birth,” or “Why didn’t they just go to a birth center?”

Well, there is an easy answer for that question that American women don’t seem to know. These options are not available to all women across the country. In fact, in that area of Ohio, there is no birth center, and midwifery care for home birth is also scarce.

First of all, there are no birth centers in Columbus, and several homebirth midwives, but only one homebirth midwife practice that has a physician back-up’ (which just felt responsible to me). But, NO insurance locally covers homebirthing, so at first, it was an economical decision. Later in my pregnancy, after we began taking NCB classes, we decided that our next baby would be at home, but there was also a measure of comfort in doing the first at the hospital, since I had no idea what to expect.

After research of my own, I decided to see really how many states have no options for out of hospital births, whether it be in a childbirth center, or at home.

First birth centers… Our of the 51 states in The United States, only excluding Puerto Rico, there are 19 states with no freestanding birth center option. Those states being:

Alabama

Arkansas

Hawaii

Illinois

Iowa

Kentucky

Maine

Mississippi

Missouri

Nebraska

Nevada

New Jersey

North Dakota

Oklahoma

Rhode Island

South Dakota

Utah

Vermont

Wyoming

That is a lot of restricted access across the United States. Women in those areas only have few options, and many of those states also have lengthy drives to the next hospital if their area hospital is not what some would call natural birth friendly.

And then we talk home birth. While home birth is not illegal in any state, there are a lot of states with legal restrictions on who can attend a home birth, meaning what kind of midwife, or provider can provide you with prenatal care and attend your birth.
In all states, Certified Nurse Midwives can attend home births, but the availability of actually finding one of these midwives who currently practice delivering at home is slim to none. I can tell you from personal experience in my state of Connecticut, there was a practice of Certified Nurse Midwives that attended home births, but once they lost their OB/GYN backup, the practiced had to stop taking on births altogether and eventually lost their midwives. Sadly we see this happening more and more.

Then there are the CPM’s or Certified Practicing Midwives. Their educational background is different than CNM’s and the legality of them practicing drastically varies. In 10 states it is illegal for these kind of midwives to attend births:

Alabama

Washington D.C.

Illinois

Indiana

Iowa

Kentucky

Maryland

North Carolina

Pennsylvania

South Dakota

Then there are the states, like my state, where these kind of midwives are neither legal, or illegal, leaving them in limbo and in fear of prosecution.

Connecticut

Ohio

Nebraska

But why does all this information even matter? Well lets take a look at home many states do not offer home birth with available midwives, and do not have any kind of childbirth center:

Arkansas

Illinois

Iowa

Kentucky

South Dakota

No options except to birth in a hospital. You would think with this kind of availability we would be talking about a small third world country, or someplace with seriously lacking medical care, not the good ol’ United States. But for the women in these areas their options are not there. And for Susan, the mother from One Born Every Minute… that meant a battle with Nurse Pam to labor and birth the way she wanted.

Unfortunately until we see some serious changes in the laws regarding maternity care, and women being able to freely make their own educated choices on birth, we will not see more options available to these women.

In some sad cases, we also have women taking matters into their own hands in desperation, and having unattended births. Whether or not these women have safe and successful births is a whole other story. But no women should be forced into birthing alone because they cannot find someone to attend their birth, or may be scared to head into their local hospitals.

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